HomeMy Public PortalAbout5323-5325 SANTA ANITA AVE_Plumbing__ 76A867 (CE-817) - 1/75 I� ! C4-� .
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ••�[�
MAKE CHECKS PAYABLE TO: ADDRESS BUILDING ltJp�
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM @ FEE OWNER �! ,(
WATER CLOSET 2.00 j � �l� S( v7!MAIL � r2
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BATH TUB 2.00 n ADDRESS Q �rJ O
SHOWER 2.00CITY t TEL. NO.
LAVATORY 2.00 CONTRACTOR
6
SINK 2.00 ADDRESS 02c
DISHWASHER 2.00 zCITY TEL. NO. ?625
CLOTHES WASHER 2.00 STATE f LIC
SWIMMING POOL RECEPTOR LICENSE NO. / CLASS
2.00 Q DISTRICT NO.Gp'QUP ZONE P SSE BY
LAWN SPRINKLER SYSTEM 2.00 l5'D8 / I� 3
WATER HEATER 2.00 D Q"-(� INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00 J a}
INSPECTION RECORD
OUTLETS OVER Q-� r } v
5 PER SYSTEM .30 �% "'!J.y��✓'�'i3 'd.'v'�-'� W '1 e C��
/ P A/G
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
may APPROVALS DATE INSPECTJOR'S SIGNATURE
.
Plan check applicant /QrS'V UNDER SLAB WORK S'�� ��'d.•�--�
Name ROUGH PLUMBING AArq& ,7.) '
Address
City Tel. No. GAS VENTS
HOT WATER HEATER 'GN Alli 4 �.? f•J
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES 11GI°
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST C�� ••t rr
1 HEREBY CERTIFY THAT I AM OPERLY STERED AND/OR UTILITY CO. NOTIFIED fo
LICENSED AS REQUIRED BY LOS ELES C A STATE OF
CALI FORNIA OR THAT 1 AM T GAL W R , fN TENb TO y-:c,•,1'�� y'c
RESIDE IN THE ABOVE DESCRI ESIDE T TY. q-q+.1 �w�y:.* ,�,.� .�qs•(
SIGNATURE � FINAL ,�"p(=• �� �V,f �.`.•;A.• n7
OF PERMITT 1
PERMIT VALIDATION CK. M.O: CASH
PLAN•CHECK VALI AT 0 CK. M.O. CASH
4 2 '1 AP,R 5 U 7 0.5 J Lid
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